Otc Practice Lec 3

HOW TO PRACTICE

O.T.C

Lecture three

foot

gout

corns or callus

Tinea pedis

Excessive walking or standingRequire rest

Redness, bad odour, itching,maceration inbetween toes (4-5)

Lesion in foot sole with black dot in center, painful on walking on it

Big toe or ankle are suddenly red , swollen, and painful

Hard lesion on bone surface oncompression sites of foot

Only pain on foot

Planter warts

yes

No

yes

yes

yes

yes

No

No

No

Treatment of Tinea pedis

topical antifungal for about 2-4 weeks

Systemic antifungal may be added

(weekly capsule of ketoconazole)

topical antifungal

1-Imidazole group:

*Miconazole (Daktarin, miconaze)®

*Clotrimazole(Candistan,colosol,Dermatin)

*Tioconazol (Trosyde)®

2 -Tolnaftate (Tinea cure)®

3 -Terbinafine (lamisil)

Topical antifungal

Topical antifungal

ketoconazole

Plantar wartscorns

Treatment of corns and warts

Salicylic acid )keratolytic action(

cover surrounded healthy tissue with Vaseline .”

Salicylic acid is contraindicated with DM. due to reduced sensation in the foot delay awareness of skin breakdown & sepsis.

Patients should never attempt to lower calluse with bladdes or files as can cause infection &

hemorrhage.

Example of OTC prescription

Callomack paintلمدة ومساًء صباحا من 21مس رقيقة بطبقة المحيط الجزًء حماية مع يوم

فازلين

Oral problems

Mouth thrush

gingivitis

Herpes simplexVesicle around the lip with history of common cold or low immunity

Painful ulcer in mouth with white covering membrane

White patches on tongue or lip or tongue disfiguring

red painful edamatous gingiva

Only pain on foot

oral sore

yes

No

yes

yes

yes

No

No

No

lips are cracked & dry yes

chapped lips

treament for Gingivitis :

Antiseptic mouth washChlorohexidine, povidone, citrimide, benzdiamine

Antibiotic or antibacterial :

Amoxicillin, metronidazole, tetracycline

AnalgesicIbuprofen, ketoprofen

treament for Gingivitis :

treament for Gingivitis :

Antiviral drug ( acyclovir)

Analgesic

treament for herpes simplex :

treament for Gingivitis :

Oral antifungal

Miconazole, nystatin

treament for mouth thrush

treament for Gingivitis :

Antiseptic mouth wash

Analgesic or anesthetic

treament for mouth sore :

.: (Jogel) ® -----> “Lidocaine + Jojob as antibacterial” (Oracure)® -----> “Lidocaine + cetylpyridinium as

Antiseptic” (Salvix – L)® -----> lignocaine + anthraqinone +SA

dental pain

Dental decay

dental abcess

physicianLoose tooth

Continous pain even on touch, bite, cold, or hot, dental fracture

Dental pain disappear in seconds cold, hot, sweaty things

Dental pain with facial swelling at jaw line, pus, fever

Give local anesthetic or analgesic

Dental hypersensitivity

yes

No

yes

yes

yes

No

No

No

Ear problems

Pus discharge

fever

sudden hear loss

Drum rupture exclude

Ear problems

otitis media

otomycosisAntifungal solution

Gradual decrease in hearingFeeling of ear fullness

Pain accompany common cold symptoms

pruritus, white scaling, and swelling

Wax impactionyes

yes

yes

No

No

No

otitis externayes

Pain on moving auricle, pain increase on chewing

NoGive local ear analgesic

Wax impaction

Ear analgesic

Eye problems

Eye redness

stye

Occular discomfort ,itching desire, eye awareness

redness

Inflammation or infectionof the sebaceous gland of the eye lash

Dry eyeyes

yes

yes

No

No

No belpharitis

yesInflammation of eye lid

No

Tearing, mild swelling below eyes & itching, allergic history

allergic conjunctivitisyes

Red eye treatment

•Ophthalamic vasoconstrictor “ sympathomimetic •Naphazoline (Prisoline) ®

•Tetrahydrozoline (Visine)®

Dry eye

Allergic conjunctivitis

1-Ophthalamic vasoconstrictor “ sympathomimetic

2-antihistaminic

loratidine

Fexofenadine

citrizine

Antihistaminic drugs

rhinorrhea

allergic rhinitis

Sneezing, family infection yellowish discharge, onset less 1

week, fever

Chronic, itching, no fever, clear watery discharge, allergic history

Common clodyes

yes

No

No

No

sinusitisyesHeadache, face pain around

sinus area, yellowish discharge, sinus congestion

No

unknown

Treatment of cold

Oral nasal decongestants: EX: phenylephrine .

Phenyl propanolamine (No flu, contaflu)®

Pseudoephedrine (Actified)®

Antihistaminic:

Analgesics: paracetamol

antihistaminic

Relieve sneezing, runny nose, nose itching

First generations : Side effects of sleepiness & drowsiness

Second generations : “No Sedation ”

First gen. antihistaminic

Sec. Antihistaminic drugs

Tinea pedis

Ex1: Clioquinol (Vioderm)

Ex2: Imidazole group:

Miconazole (Daktarin)®

Clotrimazole (Canesten, Dermatin)®

Tioconazol (Trosyde, Topozole)

Ex3: Tolnaftate (Tinea cure)

Ex4: Povidone I2 (Betadine)®

•-Topical antifungal & may accompanied with oral antifungal if sever. Ex: Diflucan

Body temperature measurements:

�ْOral “sublingual: ” Good reflex of body temperature but usually lower than body temp due to breathing from mouth while taking temp.

Tympanic:

Due to high blood flow in tympanic membrane, so reflects body temp.

Axillaries

But its validity is questionable .

Treatment

Supportive (tempogel)Cool bath, ice packs, fans reduce fever

Antipyretic: acetaminophen, Ibuprofen, ketoprofen or aspirin, declofenac

Antipyrtic should be taken after meal

NB: Aspirin should be avoided in children lower than 12 years due to risk Ray’s syndrome

paracetamol

Ibuprofen

ketoprofen

declofenac

Example of OTC prescription

Pyral syrp

االكل 3مل 10 بعد مرات

headache

sinusitis

migraine

Eye problemEye pain, blurred vision

Sinus congestion, pain in sinus areas

Throbbing pain in one side of headworsen with normal movements,

Give analgesicLike fever

yes

No yes

yesNo

No

Prevention of headache

1 -avoid high amount of caffee, tea, ice cream, chocolate

2-avoid stress and avoid change normal routine as “dieting, traveling, sleeping”

Treatment of migraine

Mild cases:

Acetaminophen plus metoclopramide

Sever cases:

Ergotamine combinationAvoid use in hypertensive patients or pregnant

Paracetamol + metoclopramide

ergotamine

Example of OTC prescription for migraine

Migracid tab

اللزوم 1-2 عند قرص

insomnia

Drug induced

Physician contactPsychological causes or sever pain

On starting drug use

Give first generation antihistaminicor natural sedating product

yes

No

yes

No

Prevention of insomnia “sleep hygiene”

1-avoid CNS stimulant drugs

2-Hunger can inhibit sleep, so not go to bed hungry.

3-Avoid coffee, smoking completely after noon.

4-Bed room should be comfortable

5-avoid napping

Treatment

Antihistaminic:

as diphenhydramine & doxylamine at bedtime

Plant extracts:

Valerians (Dormival)®

Kava kava extract (kava)®

Plant extracts

First gen. antihistaminic

Example of OTC prescription:

Kava cap

النوم 2 – 1 قبل يوميا كبسوالتAvil retard tab

النو قبل يوميا م قرص

Fatigue & weakness

anemia

hyperthyroidism

Common coldFever & rhinorhea, sneezing

Recurrent Hypotension, palpitation, pale skin

Unintended potent weight loss, good appetite, sweating, tachycardia, nervousness

Overworking or under eating is the cause

yes

Noyes

yesNo

No

Drug inducedOn starting drug useyes

Treatment: “for fatigue & weakness

1-Caffeine stimulant:

NB: too much caffeine may cause nervousness, irritability & no sleep.

2-multivitamins

-Supply vitamins and minerals and energizers

-Avoid those concentrate on iron or calcium

-Multivitamins are taken once daily after meal

multivitamins1 -royal jelly

2 -vitamins and minerals

2 -ginseng

4 -wheat germ oil

5 -antioxidant

6 -Bee pollen

multivitamins

Example of OTC prescription:

Royal jelly 600 mg tab

الغداًء بعد يوميا كبسولة

Back pain

Renal stone or infection

Sciatica (disc)

physicianAccident, fall, injury

Urine problem

Numbness or pain in one leg

Give analgesic, muscle relaxant

yes

Noyes

yesNo

NoOsteoarthritis or

rheumatic arthritisChronic pain, inflammation,

stiffness In both sides of joints

yes

Treatment of back pain

1 -analgesic:acetaminophen, Ibuprofen, ketoprofen or aspirin, declofenac, piroxicam,celecoxib, nimasulide, indomethacin

2-muscle relaxntEX 1 :- Baclofen(Baclofen).® EX 2 :- Chlozoxazone (Myolgine) .®

EX 3:- Orphenadrine (Norflex).®

3-counter irritantMask the painNot applied to wound or damaged skin

AntiCox 2

indomethacin

Muscle relaxant and analgesic

Example of OTC prescription:

myolgin cap

االكل 3كبسولة بعد مراتOlfen amp

يوميا عضل حقنة

cough

Physician contact

Interfere with sleep or activity or painful

Respiratory infectionFever

Asthmatic patient

dry cough

Give antitussive

yes

Noyes

yesNo

No

Give mucolytic or expectorant

Productive

yes

cough suppressant + expectorant

yes

No

Cough

Cough removes foreign bodies, so not recommend selling a cough suppressant to

smokers.

Productive cough brings up accumulated mucus preventing pneumonia, so must be allowed to be continued for its cleansing effect

Treatment productive cough

Bromohexyine (Bisolvon)®

Ambroxol (Ambroxol)®

Active metabolite of bromohexine

Acetyl cystiene: (Acetyl cystiene) ® Powder

Carboxy methyl cystiene ( solvex):

mucolytic

mucolytic

Treatment of dry cough

Cough suppressant ( antitussive) Central:

codeine Diphenhydramine; Dextromethorphane; Noscapine”, Pipozethate, Butamirate

Peripheral: camphor & Menthol

Codeine&Dextromethorphane have the risk of abuse ( addiction)& constipation.

antitussive

antitussive

Expectorant & cough suppressant

Guaifensin

Ammonium cl

Tr. Ipeca

Tr. Squill

KI

Diphenhydramine

Dextromethorphane ;

Camphor

Menthol”

Antitussive+ expectorant

Natural preparations for cough

They act as cough suppressant and expectorant

Examples:

Guava leaves, fennel, thyme, honey, tilia, comphor, mentol.

Suitable for pregnant, patients with kideny, liver disorder.

Natural cough product

Example of OTC prescription for productive cough:

muco syrup

االكل بعد كبيرة مرات 3معلقة

Example of OTC prescription for dry cough:

sinecode syrup

االكل بعد كبيرة مرات 3معلقة

Example of OTC prescription forproductive interfere with sleep

Toplexil syrup

االكل بعد كبيرة مرات 3معلقة